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Tawada K, Higaki E, Abe T, Takatsu J, Fujieda H, Nagao T, Komori K, Ito S, Yoshida M, Oze I, Shimizu Y. Maximum phonation time: an independent predictor of late-onset pneumonia after esophageal cancer surgery. Dis Esophagus 2023; 36:doad023. [PMID: 37183605 DOI: 10.1093/dote/doad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/30/2023] [Indexed: 05/16/2023]
Abstract
Dysphagia after esophagectomy is a major risk factor for aspiration pneumonia, thus preoperative assessment of swallowing function is important. The maximum phonation time (MPT) is a simple indicator of phonatory function and also correlates with muscle strength associated with swallowing. This study aimed to determine whether preoperative MPT can predict postoperative aspiration pneumonia. The study included 409 consecutive patients who underwent esophagectomy for esophageal cancer between 2017 and 2021. Pneumonia detected by routine computed tomography on postoperative days 5-6 was defined as early-onset pneumonia, and pneumonia that developed later (most often aspiration pneumonia) was defined as late-onset pneumonia. The correlation between late-onset pneumonia and preoperative MPT was investigated. Patients were classified into short MPT (<15 seconds for males and <10 seconds for females, n = 156) and normal MPT groups (≥15 seconds for males and ≥10 seconds for females, n = 253). The short MPT group was significantly older, had a lower serum albumin level and vital capacity, and had a significantly higher incidence of late-onset pneumonia (18.6 vs. 6.7%, P < 0.001). Multivariate analysis showed that short MPT was an independent risk factor for late-onset pneumonia (odds ratio: 2.26, P = 0.026). The incidence of late-onset pneumonia was significantly higher in the short MPT group (15.6 vs. 4.7%, P = 0.004), even after propensity score matching adjusted for clinical characteristics. MPT is a useful predictor for late-onset pneumonia after esophagectomy.
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Affiliation(s)
- Kakeru Tawada
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Jun Takatsu
- Department of Rehabilitation, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hironori Fujieda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuya Nagao
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Yoshida
- Department of Rehabilitation, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Derrey S, Chastan N, Maltete D, Verin E, Dechelotte P, Lefaucheur R, Proust F, Freger P, Leroi AM, Weber J, Gourcerol G. Impact of deep brain stimulation on pharyngo-esophageal motility: a randomized cross-over study. Neurogastroenterol Motil 2015; 27:1214-22. [PMID: 26053217 DOI: 10.1111/nmo.12607] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bilateral subthalamic nucleus (STN) stimulation is used to alleviate Parkinson's disease (PD) motor symptoms. Recently, it has been shown that this therapeutic also increased gut cholinergic contractions. We therefore investigated the effect of STN stimulation on esophageal motility in an interventional randomized study. METHODS Sixteen humans PD patients (4 women, 12 men; age: 62.4 ± 9.3-years old) who underwent STN stimulation for at least 6 months were randomly evaluated with either stimulator turned OFF then ON, or inversely. Esophageal high resolution manometry was performed at the end of each ON and OFF period, with a 5 min resting period followed by ten swallows of 5 mL. KEY RESULTS During the ON, an increase in the distal contractility index was found (OFF: 1750 ± 629 vs ON: 2171 ± 755 mmHg/cm/s; p = 0.03), with no difference in the distal front velocity. A decrease in the integrative relaxation pressure of the lower esophageal sphincter (LES) was noted (OFF: 11.1 ± 1.8 mmHg vs ON: 7.2 ± 1.8 mmHg; p < 0.05) in ON. The LES resting pressure remained unchanged during the two periods. This resulted in a decrease in the intrabolus pressure (p = 0.03). No difference was observed for the upper esophageal sphincter, nor the pharyngeal contraction amplitude and velocity. CONCLUSIONS & INFERENCES In conclusion, STN stimulation in PD patients increased esophageal body contractions and enhanced the LES opening. This suggests that the nigrostriatal-striatonigral loop is involved in the control of esophageal motility.
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Affiliation(s)
- S Derrey
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - N Chastan
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - D Maltete
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - E Verin
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - P Dechelotte
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - F Proust
- Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - P Freger
- Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - A M Leroi
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - J Weber
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.,Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France
| | - G Gourcerol
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
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Kollarik M, Brozmanova M. Cough and gastroesophageal reflux: insights from animal models. Pulm Pharmacol Ther 2008; 22:130-4. [PMID: 19138751 DOI: 10.1016/j.pupt.2008.12.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 12/21/2008] [Accepted: 12/23/2008] [Indexed: 12/17/2022]
Abstract
Chronic cough in gastroesophageal reflux disease (GERD) has been attributed to irritation of the esophagus and/or upper airways by reflux of gastric content. Animal models have provided insight into both of these putative mechanisms. In patients with chronic cough and GERD, stimuli associated with reflex in the esophagus sensitize the cough reflex. This sensitization can be reproduced in the guinea pig and is most likely mediated by the esophageal afferent nerve fibers carried by the vagus nerves. Studies in animals have identified several subtypes of vagal esophageal C-fibers that may subserve this function. The putative nociceptive vagal C-fibers in the guinea pig esophagus are stimulated by acid and express the TRPV1 and TRPA1 receptors that confer responsiveness to disparate noxious stimuli. Acute and/or chronic irritation of the upper airways by reflux may contribute to cough by stimulation and/or sensitization of the airway afferent nerves. Studies in animals have identified airway nerves that likely initiate cough due to aspirated reflux; have characterized their pharmacology; and have provided insight into changes of their sensitivity. Studies in animal models have also described the neurophysiology of reflexes that protect the airways from reflux. In conclusion, animal models provide mechanistic insight into the modulation of cough from the esophagus and the pharmacology of neural pathways mediating cough in GERD.
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Affiliation(s)
- Marian Kollarik
- Department of Medicine, The Johns Hopkins University School of Medicine, JHAAC 3A18, Baltimore, MD 21224, USA.
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Perera L, Kern M, Hofmann C, Tatro L, Chai K, Kuribayashi S, Lawal A, Shaker R. Manometric evidence for a phonation-induced UES contractile reflex. Am J Physiol Gastrointest Liver Physiol 2008; 294:G885-91. [PMID: 18239061 DOI: 10.1152/ajpgi.00470.2007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The mechanism against entry of gastric content into the pharynx during high-intensity vocalization such as seen among professional singers is not known. We hypothesized that phonation-induced upper esophageal sphincter (UES) contraction enhances the pressure barrier against entry of gastroesophageal contents into pharynx. To determine and compare the effect of phonation on luminal pressures of the esophagus and its sphincters, we studied 17 healthy volunteers (7 male, 10 female) by concurrent high-resolution manometry and voice analysis. We tested high- and low-pitch vowel sounds. Findings were verified in six subjects by UES manometry using a water-perfused sleeve device. Eight of the volunteers (2 male, 6 female) had concurrent video fluoroscopy with high-resolution manometry and voice recording. Fluoroscopic images were analyzed for laryngeal movement. To define the sex-based effect, subgroup analysis was performed. All tested phonation frequencies and intensities induced a significant increase in UES pressure (UESP) compared with prephonation pressure. The magnitude of the UESP increase was significantly higher than that of the distal esophagus, the lower esophageal sphincter (LES), and the stomach. Concurrent videofluoroscopy did not show posterior laryngeal movement during phonation, eliminating a purely mechanical cause for phonation-induced UESP increase. Subgroup analysis demonstrated phonation-induced UESP increases in males that were significantly greater than those of females. Phonation induces a significant increase in UESP, suggesting the existence of a phonation-induced UES contractile reflex. UESP increase due to this reflex is significantly higher than that of the distal esophagus, LES, and stomach. The phonation-induced UESP increase is influenced by sex.
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Affiliation(s)
- Lilani Perera
- Division of Gastroenterology and Hepatology, Froedtert Hospital/Medical College of Wisconsin Dysphagia Institute, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA
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Wilson JA. What is the evidence that gastroesophageal reflux is involved in the etiology of laryngeal cancer? Curr Opin Otolaryngol Head Neck Surg 2005; 13:97-100. [PMID: 15761283 DOI: 10.1097/01.moo.0000156170.70827.46] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review recent literature on the possible mechanisms and role of gastroesophageal reflux in the etiology of laryngeal cancer, in patients with and without the accepted risk factors of smoking and alcohol consumption. RECENT FINDINGS A recent systematic review was not conclusive. The issue remains a popular one for small-scale clinical surveys, when different inclusion criteria and a range of diagnostic tests are used. SUMMARY After three decades of interest, there is still no unequivocal evidence for the role of reflux in the etiology of laryngeal cancer, whether in smokers or in nonsmokers.
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Affiliation(s)
- Janet A Wilson
- Department of Otolaryngology--Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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